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Degenerative aortic stenosis accounts for the majority of native valve disease.1 Surgical aortic valve replacement is a treatment option that provides good outcome in the majority of the patients, with good durability of the prosthetic valve.w1 However, a large proportion of patients with severe aortic stenosis are not referred for, or denied, surgery. The Euro Heart Survey on valvular heart disease demonstrated that up to 33% of the patients with severe aortic stenosis did not undergo surgery, although there was an indication.2 Patient’s age and (multiple) comorbidities were the main reasons for denial of surgery.w2 Therefore, there is a need for a less invasive treatment option in older patients with severe aortic stenosis.
In the past few years, new percutaneous aortic valve implantation procedures have been introduced.w3 Two different types of percutaneous aortic valve prostheses now have approval in Europe. In addition, European3 and American4 5 recommendations on percutaneous aortic valve implantation have been published.
In this article, the clinical experience with the two different percutaneous aortic valves will be reviewed. In addition, the role of different imaging modalities in the selection of patients, guidance during percutaneous aortic valve implantation, and follow-up will be discussed.
Prostheses and clinical experience
Currently, two different types of percutaneous aortic valve devices are commercially available. The balloon expandable Edwards SAPIEN valve (Edwards Lifesciences Inc, Irvine, California, USA) and the self expanding CoreValve Revalving prosthesis (CoreValve Inc, Irvine, California, USA). At present, more than 2500 patients worldwide have been treated with percutaneous aortic valve implantation, and the number of studies reporting the clinical experience and results with percutaneous aortic valve procedures is rapidly growing (table 1). In the following paragraphs, technical aspects of the different prostheses and clinical experience with percutaneous aortic valve implantations will be reviewed.